publishedmedium:new england journal of medicine

COMPare: a prospective cohort study correcting and monitoring 58 misreported trials in real time | Trials | Full Text
▻https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3173-2

https://images.springer.com/sgw/journals/medium/13063.jpg

Methods

We identified five high-impact journals endorsing Consolidated Standards of Reporting Trials (CONSORT) (New England Journal of Medicine, The Lancet, Journal of the American Medical Association, British Medical Journal, and Annals of Internal Medicine) and assessed all trials over a six-week period to identify every correctly and incorrectly reported outcome, comparing published reports against published protocols or registry entries, using CONSORT as the gold standard. A correction letter describing all discrepancies was submitted to the journal for all misreported trials, and detailed coding sheets were shared publicly. The proportion of letters published and delay to publication were assessed over 12 months of follow-up. Correspondence received from journals and authors was documented and themes were extracted.

[...]

Conclusions

All five journals were listed as endorsing CONSORT, but all exhibited extensive breaches of this guidance, and most rejected correction letters documenting shortcomings. Readers are likely to be misled by this discrepancy. We discuss the advantages of prospective methodology research sharing all data openly and pro-actively in real time as feedback on critiqued studies. This is the first empirical study of major academic journals’ willingness to publish a cohort of comparable and objective correction letters on misreported high-impact studies. Suggested improvements include changes to correspondence processes at journals, alternatives for indexed post-publication peer review, changes to CONSORT’s mechanisms for enforcement, and novel strategies for research on methods and reporting.

#laxisme #biais #prestige #recherche #publications

Cancer de la prostate : le suivi fait aussi bien que la chirurgie
▻http://www.pourquoidocteur.fr/Articles/Question-d-actu/17558-Cancer-de-la-prostate-le-suivi-fait-aussi-bien-que-la-chirurgi

L’ablation de la prostate n’est pas toujours justifiée lorsqu’un cancer est détecté. L’approche à adopter est régulièrement discutée. Une étude parue en deux volets dans le New England Journal of Medicine pourrait bien trancher ce débat pour de bon. Réalisée par l’université d’Oxford (Royaume-Uni), elle montre qu’entre la chirurgie, la radiothérapie et une surveillance active, aucune différence n’émerge sur la survie. Pourtant, les travaux ont été réalisés pendant une décennie, auprès de 82 429 hommes de 50 à 69 ans.

How the sugar industry has distorted health science for more than 50 years
▻http://www.vox.com/2016/9/12/12864442/jama-sugar-industry-distort-science

“[...] Is it really true that food companies deliberately set out to manipulate research in their favor? Yes, it is, and the practice continues.” Nestle has been documenting the instances where companies fund nutrition studies that overwhelmingly return favorable results to the industry sponsors.

“Our research emphasizes that industry-funded science needs to be heavily scrutinized, and not taken at face value,” said Kearns, the lead author on the JAMA paper. “There are so many ways a study can be manipulated — from the questions that are asked, from how the information is analyzed, even to how the conclusions are described in the paper.”

In this case, the sugar industry involvement in science influenced not only the scientific enterprise but also public-health policy, and potentially, the health of millions of people. Kearns points out that the most recent World Health Organization sugar guidelines focus on reducing consumption because of sugar’s role in obesity and tooth decay — not the heart risk.

#sucre #santé

Smartphone use in the dark linked to temporary blindness in 2 cases
▻http://mashable.com/2016/06/23/temporary-blindness-tied-to-smartphones/#wUKUpGc1Ckqw

In Thursday’s New England Journal of Medicine, doctors detailed the cases of the two women, ages 22 and 40, who experienced “transient smartphone blindness” for months.

The women complained of recurring episodes of temporary vision loss for up to 15 minutes. They were subjected to variety of medical exams, MRI scans and heart tests. Yet doctors couldn’t find anything wrong with them to explain the problem.

But minutes after walking into an eye specialist’s office, the mystery was solved.

“I simply asked them, ’What exactly were you doing when this happened?’” recalled Dr. Gordon Plant of Moorfield’s Eye Hospital in London.

He explained that both women typically looked at their smartphones with only one eye while resting on their side in bed in the dark — their other eye was covered by the pillow.
[…]
He said the temporary blindness was ultimately harmless, and easily avoidable, if people stuck to looking at their smartphones with both eyes.

The best health care system in the world? Nonsense!
▻http://www.publicintegrity.org/2015/06/01/17426/best-health-care-system-world-nonsense

To understand how foolish we are, let’s consider the war of words that recently erupted between health insurers and drug companies.

First, though, let’s take a look at a new study that compares how much Americans pay for prescription medication compared to what folks in a few other industrialized countries pay.

The study, released last week by the Kaiser Permanente Institute for Health Policy, showed that pharmaceutical spending in the U.S. per capita had reached $1,010 in 2012. The next highest spender was Germany at $668 per capita. Australia came in at $558.

Am I the only one who finds it more than a little upsetting that the Germans spend 66 percent of what we spend for drugs and the Aussies spend just 55 percent?

As the Kaiser researchers point out, those countries’ citizens get a much better deal on their meds because their federal governments have policies in place to regulate drug prices. And those nations are not alone. Every other country in the developed world has instituted some kind of price control mechanism. Except, of course, the United States.

Kaiser’s numbers are consistent with those from a 2013 analysis by the 34-member Organization for Economic Cooperation and Development (OECD), which showed that Americans spend 40 percent more on drugs than the next highest spender, Canada.

As PBS pointed out last year in a report on drug prices around the world, government agencies in other countries set limits on how much they (and their citizens) will pay drug makers for their various products.

“By contrast,” as PBS further pointed out, “in the U.S., insurers typically accept the price set by the makers for each drug, especially when there is no competition in a therapeutic area, and then cover the cost with high copayments.” (Emphasis mine.)

PBS nailed it. American insurance companies are essentially powerless when it comes to negotiating prices with Big Pharma, just as they are becoming increasingly powerless in controlling the cost of hospital care and physician services. The way insurers continue to make money is not by doing a good job for their customers but by constantly shifting more of the cost of care to those customers.

If we were paying close enough attention to what insurers were saying during the health care reform debate, we would have realized that they are, for all practical purposes, impotent when it comes to holding down costs. All we had to do was read between the lines.

#santé #etats-Unis #

An open letter for the people in #Gaza
▻http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961044-8/fulltext

En attendant l’étasunien “New England Journal of Medicine,”

We denounce the myth propagated by Israel that the aggression is done caring about saving civilian lives and children’s wellbeing.

Israel’s behaviour has insulted our humanity, intelligence, and dignity as well as our professional ethics and efforts. Even those of us who want to go and help are unable to reach Gaza due to the blockade.

This “defensive aggression” of unlimited duration, extent, and intensity must be stopped.

Additionally, should the use of gas be further confirmed, this is unequivocally a war crime for which, before anything else, high sanctions will have to be taken immediately on Israel with cessation of any trade and collaborative agreements with Europe.

As we write, other massacres and threats to the medical personnel in emergency services and denial of entry for international humanitarian convoys are reported.6 We as scientists and doctors cannot keep silent while this crime against humanity continues. We urge readers not to be silent too.

Gaza trapped under siege, is being killed by one of the world’s largest and most sophisticated modern military machines. The land is poisoned by weapon debris, with consequences for future generations. If those of us capable of speaking up fail to do so and take a stand against this war crime, we are also complicit in the destruction of the lives and homes of 1·8 million people in Gaza.

We register with dismay that only 5% of our Israeli academic colleagues signed an appeal to their government to stop the military operation against Gaza. We are tempted to conclude that with the exception of this 5%, the rest of the Israeli academics are complicit in the massacre and destruction of Gaza. We also see the complicity of our countries in Europe and North America in this massacre and the impotence once again of the international institutions and organisations to stop this massacre.

Our Feel-Good War on Breast Cancer - NYTimes.com
▻http://www.nytimes.com/2013/04/28/magazine/our-feel-good-war-on-breast-cancer.html

In the United States, some researchers credit screening with a death-rate reduction of 15 percent — which holds steady even when screening is reduced to every other year. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and co-author of last November’s New England Journal of Medicine study of screening-induced overtreatment, estimates that only 3 to 13 percent of women whose cancer was detected by mammograms actually benefited from the test.

If Welch is right, the test helps between 4,000 and 18,000 women annually. Not an insignificant number, particularly if one of them is you, yet perhaps less than expected given the 138,000 whose cancer has been diagnosed each year through screening. Why didn’t early detection work for more of them? Mammograms, it turns out, are not so great at detecting the most lethal forms of disease — like triple negative — at a treatable phase. Aggressive tumors progress too quickly, often cropping up between mammograms. Even catching them “early,” while they are still small, can be too late: they have already metastasized. That may explain why there has been no decrease in the incidence of metastatic cancer since the introduction of screening.

At the other end of the spectrum, mammography readily finds tumors that could be equally treatable if found later by a woman or her doctor; it also finds those that are so slow-moving they might never metastasize. As improbable as it sounds, studies have suggested that about a quarter of screening-detected cancers might have gone away on their own. For an individual woman in her 50s, then, annual mammograms may catch breast cancer, but they reduce the risk of dying of the disease over the next 10 years by only .07 percent — from .53 percent to .46 percent. Reductions for women in their 40s are even smaller, from .35 percent to .3 percent.

If screening’s benefits have been overstated, its potential harms are little discussed. According to a survey of randomized clinical trials involving 600,000 women around the world, for every 2,000 women screened annually over 10 years, one life is prolonged but 10 healthy women are given diagnoses of breast cancer and unnecessarily treated, often with therapies that themselves have life-threatening side effects.